RESUMO
OBJECTIVES: We examined the data reported in studies for diagnostic purposes and to discuss whether their intended use could be extended to triage, as rule-in or rule-out tests to select individuals who should undergo further confirmatory tests. METHODS: We searched Scopus, PubMed and Web of Science with the terms 'acute phase proteins,' 'IP-10,' 'tuberculosis,' 'screening' and 'diagnosis,' extracted the sensitivity and specificity of the biomarkers and explored methodologic differences to explain performance variations. Summary estimates were calculated using random-effects models for overall pooled accuracy. The hierarchical summary receiver operating characteristic model was used for meta-analysis. RESULTS: We identified 14, four and one studies for C-reactive protein (CRP), interferon γ-induced protein 10 (IP-10) and alpha-1-acid glycoprotein (AGP). The pooled CRP sensitivity/specificity (95% confidence interval) was 89% (80-96) and 57% (36-65). Sensitivity/specificity were higher in high-tuberculosis-burden countries (90%/64%), HIV-infected individuals (91%/61%) and community-based studies (90%/62%). IP-10 sensitivity/specificity in TB vs. non-TB studies was 85%/63% and in TB and HIV coinfected vs. other lung conditions 94%/21%. However, IP-10 studies included diverse populations and a high risk of bias, resulting in very low-quality evidence. AGP had 86%/93% sensitivity/specificity. CONCLUSIONS: Few studies have evaluated CRP, IP-10 and AGP for the triage of symptomatic patients. Their high sensitivity and moderate specificity warrant further prospective studies exploring whether their combined use could optimize performance.
Assuntos
Proteínas de Fase Aguda/metabolismo , Quimiocina CXCL10/sangue , Tuberculose/diagnóstico , Humanos , Tuberculose/sangueRESUMO
BACKGROUND: Leishmania (Viannia) guyanensis is believed to be the principal cause of cutaneous leishmaniasis (CL) in Suriname. This disease is treated with pentamidine isethionate (PI), but treatment failure has increasingly been reported. AIM: To evaluate PI for its clinical efficacy, to compare parasite load, and to assess the possibility of treatment failure due to other infecting Leishmania species. METHODS: Parasite load of patients with CL was determined in skin biopsies using real-time quantitative PCR before treatment and 6 and 12 weeks after treatment. Clinical responses were evaluated at week 12 and compared with parasite load. In parallel, molecular species differentiation was performed. RESULTS: L. (V.) guyanensis was the main infecting species in 129 of 143 patients (about 90%). PI treatment led to a significant decrease (P < 0.001) in parasite counts, and cured about 75% of these patients. Treatment failure was attributable to infections with Leishmania (Viannia) braziliensis, Leishmania (Leishmania) amazonensis and L. (V.) guyanensis (1/92, 1/92 and 22/92 evaluable cases, respectively). There was substantial agreement beyond chance between the parasite load at week 6 and the clinical outcome at week 12, as indicated by the κ value of 0.61. CONCLUSIONS: L. (V.) guyanensis is the main infecting species of CL in Suriname, followed by L. (V.) braziliensis and L. (L.) amazonensis. Furthermore, patient response to PI can be better anticipated based on the parasite load 6 weeks after the treatment rather than on parasite load before treatment.
Assuntos
Leishmania/isolamento & purificação , Leishmaniose Cutânea/tratamento farmacológico , Pentamidina/farmacologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Pele/parasitologia , Adolescente , Adulto , Idoso , Antiprotozoários/uso terapêutico , Feminino , Humanos , Injeções Intramusculares , Leishmania/efeitos dos fármacos , Leishmania/crescimento & desenvolvimento , Leishmania braziliensis/efeitos dos fármacos , Leishmania braziliensis/crescimento & desenvolvimento , Leishmania braziliensis/isolamento & purificação , Leishmania guyanensis/efeitos dos fármacos , Leishmania guyanensis/crescimento & desenvolvimento , Leishmania guyanensis/isolamento & purificação , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/patologia , Masculino , Pessoa de Meia-Idade , Carga Parasitária/métodos , Pentamidina/administração & dosagem , Prevalência , Pele/efeitos dos fármacos , Pele/patologia , Suriname/epidemiologia , Falha de Tratamento , Resultado do Tratamento , Adulto JovemRESUMO
En el Servicio de Otorrinolaringología del Hospital "Dr. Domingo Luciani", se reportan laringectomías parciales desde 1986, por lo que nos propusimos evaluar nuestra experiencia desde el punto de vista foniátrico en el manejo de estas intervenciones. La muestra consistió en 3 laringectomías glóticas hasta el 2000 y a partir de ese año: 3 cordectomías vía laringofisura, 4 laringectomías glóticas, 8 hemilaringectomías verticales, 2 laringectomías supraglóticas y 6 laringectomías supracricoideas. De éstas últimas, 5 reconstruidos mediante cricohioidoepiglotopexia (CHEP) y 1 mediante cricohioidopexia (CHP). Se revisó la evaluación de voz y respiración pre y postoperatoria, evolución de la deglución, grado de aspiración y la estrategia de rehabilitación, dieta, tiempo de decanulación (retiro del traqueostomo), retiro de sonda nasogástrica (SNG) y percepción de la voz por el examinador. Se le realizó evaluación foniátrica preoperatoria a 16 de los 23 pacientes operados a partir de 2000. En esta evaluación, todos los pacientes presentaron deterioro franco de los parámetros vocálicos: cualidades de voz, duración fonatoria y parámetros respiratorios: patrón respiratorio, tiempo de retención y emisión, coordinación fonorespiratoria y no se detectaron trastornos deglutorios. En la evaluación postoperatoria: se reportó aspiración en 14 pacientes, la cual se clasificó utilizando la escala de Leipzig y Pearson 7: 8 pacientes grado 1, 1 paciente grado 2, 5 pacientes grado 3. Se inició la rehabilitación foniátrica postoperatoria entre el día 1 y 18, con promedio de 8. La decanulación se realizó entre el día 3 y 78, con promedio de 16 días y el retiro de SNG entre el día 4 y 82, con un promedio de 21 días. Se reportó deglución sin aspiración, en un tiempo variable entre un mes y un año con media de 6 meses. Los resultados son los comparables con los reportados en la literatura.
Assuntos
Humanos , Masculino , Feminino , Laringectomia , Neoplasias Laríngeas/diagnóstico , Fonação , Otolaringologia , VenezuelaRESUMO
En el Servicio de Otorrinolaringología del Hospital "Dr. Domingo Luciani", se reportan laringectomías parciales desde 1986, por lo que nos propusimos evaluar nuestra experiencia desde el punto de vista foniátrico en el malicio de estas intervenciones. La muestra consistió en 3 laringectomías glótivas hasta el 2000 y a partir de ese año: 3 cordectomías vía laringofisura, 4 laringectomías glóticas, 8 hemilaringectomías verticales, 2 laringectomías supraglóticas y 6 laringectomías supracrocoideas. De éstas últimas, 5 reconstruidos mediante cricohioidoepiglotopexia (CHEP) y 1 mediante cricohioidopexia (CHP). Se reviso la evaluación de voz y respiración pre y postoperatoria, evolución de la deglución, grado de aspiración y la estrategia de rehabilitación, dieta, tiempo de decanulación (retiro del traqueostomo), retiro de sonda nasogástrica (SNG) y percepción de la voz por el examinador. Se le realizó evaluación foniátrica preoperatoria a 16 de los 23 pacientes operados a partir del 2000. En esta evaluación, todos los pacientes presentaron deterioro franco de los parámetros vocálicos: cualidades de voz, duración fonatoria y parámetros respiratorios: patrón respiratorio, tiempo de retención y emisión, coordinación fonorespiratona y no se detectaron trastornos deglutorios
Assuntos
Masculino , Feminino , Humanos , Neoplasias Laríngeas , Laringectomia , Distúrbios da Voz , Otolaringologia , VenezuelaRESUMO
Craniopharyngioma is the most common childhood tumor and thought to arise from embryonic remnants of Rathke's pouch. The paucity of published data on the molecular basis of these tumors prompted us to examine 22 adamantinomatous craniopharyngiomas looking for genetic abnormalities. Using the X-linked polymorphic androgen receptor gene as a tool for X-chromosome inactivating analysis, we found that a subset of craniopharyngiomas are monoclonal and therefore are probably due to acquired somatic genetic defects. Thus, we investigated these tumours for mutations within three candidate genes, Gsalpha, Gi2alpha and patched (PTCH). Using single stranded conformational polymorphism (SSCP), denaturing gradient gel electrophoresis and direct sequencing, the presence of somatic mutations in these genes could not be demonstrated in any tumor. Our data indicate that a subset of craniopharyngiomas are monoclonal and the mutations in the PTCH, Gsalpha, and Gi2alpha contribute little if any to craniopharyngioma development.
Assuntos
Adenoma/genética , Neoplasias Encefálicas/genética , Craniofaringioma/genética , Subunidades alfa Gi-Go de Proteínas de Ligação ao GTP/genética , Subunidades alfa Gs de Proteínas de Ligação ao GTP/genética , Proteínas Proto-Oncogênicas/genética , Adenoma/patologia , Anticorpos Monoclonais , Neoplasias Encefálicas/patologia , Craniofaringioma/patologia , Primers do DNA , Éxons/genética , Subunidade alfa Gi2 de Proteína de Ligação ao GTP , Humanos , Mutação/genética , Polimorfismo Conformacional de Fita Simples , Desnaturação Proteica , Reação em Cadeia da Polimerase Via Transcriptase ReversaRESUMO
Poorer birth outcomes have been documented among U.S.-born women of Mexican descent when compared with Mexican immigrant women. Behavioral changes that are associated with acculturation may contribute to these deteriorating outcomes. Prenatal health promotion advice can alter prenatal risk behaviors. The growing diversity of the U.S. population during the 1990s heightens the importance of examining the cultural relevance of current health promotion practices. This study examines disparities in the reported receipt of health behavior advice during pregnancy among U.S.-born women of Mexican origin and Mexican immigrant women in California. Data for the analysis are from the 1994-95 California Pregnancy Risk Assessment Monitoring System. The study sample includes 1,423 women of Mexican descent. All participants had a live birth in California between January 1994 and December 1995. Women were interviewed about the prenatal counseling they received related to diet, smoking, and alcohol use. Logistic regression was used to analyze the likelihood of reporting advice after controlling for sociodemographic and health system characteristics. Immigrant women were more likely than the U.S.-born to report receipt of prenatal advice on smoking, alcohol, and diet (OR = 1.83, p < .05) despite evidence of the lower prevalence of related health risks among Mexican-born women. Culturally appropriate prenatal counseling would emphasize the maintenance of traditional protective behaviors among less acculturated foreign-born women, and the prevention or cessation of those risk behaviors among the more acculturated women.
Assuntos
Antígenos HLA-DR/imunologia , Dados de Sequência Molecular , Epitopos/imunologia , Fragmentos de Peptídeos/imunologia , População Branca , Hanseníase/imunologia , Leucócitos Mononucleares/imunologia , Linfócitos T/imunologia , Mycobacterium leprae/imunologia , Nepal , Proteínas Recombinantes/imunologia , Proteínas de Bactérias/imunologia , Proteínas de Choque Térmico/imunologia , Sequência de Aminoácidos , Tuberculose/imunologia , Vacina BCG/imunologiaAssuntos
Antígenos de Bactérias/imunologia , Ativação Linfocitária/imunologia , Dados de Sequência Molecular , Epitopos/imunologia , Hanseníase/imunologia , Homologia de Sequência de Aminoácidos , Linfócitos T/imunologia , Mycobacterium leprae/imunologia , Mycobacterium leprae/química , Mycobacterium tuberculosis/imunologia , Mycobacterium tuberculosis/química , Peptídeos/imunologia , Peptídeos/química , Peptídeos/síntese química , Peso Molecular , Proteínas Recombinantes/imunologia , Proteínas de Choque Térmico/imunologia , Proteínas de Choque Térmico/química , Sequência de Aminoácidos , Tuberculose Pulmonar/imunologia , Vacina BCG/imunologiaRESUMO
Workers of the Neotropical termite Microcerotermes arboreus distinguish nest mates from other conspecifics by odor. A controlled breeding experiment demonstrated a genetic component to variation in colony odors. Workers were less aggressive toward unfamiliar relatives than toward nonrelatives and distinguished degree of relatedness among unfamiliar workers. Unfamiliar relatives were attacked more often than nest mates, despite similar levels of genetic relatedness; thus, nest-mate recognition is not based solely upon heritable characteristics of individual workers. No difference was detected between the effects of cues inherited through the mother and cues inherited through the father.
RESUMO
RNA has been isolated from adult Nippostrongylus brasiliensis (NB) homogenized in guanidium isothiocyanate. The mRNA has been translated in vitro utilizing a rabbit reticulocyte system and translated products immunoprecipitated with rabbit anti-adult NB antiserum and rat infection serum.